Emergencies caused by acute neurological disorders and injuries are common and the health burden of these conditions to patients and society is enormous. The outcome of many neurological disorders is often determined within the first minutes after onset and intervention in the emergency department or even prior to emergency department arrival may be necessary to provide meaningful benefit. The optimal treatments for these conditions are not actually known, in part because the clinical research enterprise in the United States has not been oriented toward studying interventions in the earliest phases of disease progression. Conducting multicenter clinical trials of therapies for illnesses with such high stakes and contracted time scales will require innovative thinking and redesign of many aspects of the science of clinical trials. To be effective and fast, The Neurological Emergencies Treatment Trials (NETT) Network will require the clinicians and providers at the front lines of emergency care to create local infrastructures that can effectively recruit patients into trials across the spectrum of neurological emergencies. With this application we propose to become one of the Hubs described in the RFA-NS-06-009 Neurological Emergencies Treatment Trials (NETT) Network Clinical Site Hubs. We will build upon our extensive prior experience with our highly effective, scalable Hub and Spoke system based out of the University of Cincinnati, College of Medicine. The key elements of this structure include an interdisciplinary team of emergency physicians, neurologists, neurosurgeons, neuroradiologists, physiatrists, pre-hospital providers, pediatricians, trauma surgeons, and intensivists all with specific expertise in the conduct of emergent clinical trials. Our Hub and Spoke system has tremendous enrollment capabilities and specifically has the ability to enroll patients in both our large academic center as well as our community hospital emergency departments. In addition we have access to the entire span of the patient demographic as well as the gamut of neurological disease processes. We have the support of clinicians, administrators and a strong public outreach. We will expand on our already proven network to be ready to perform the diverse trials brought forward for the Neurological Emergencies Treatment Trials (NETT) Network. We will be a powerful force in recruitment of patients into the broad spectrum of acute neurological clinical trials that are engaged by the NETT Network.